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Intake & Approval Sheet (FOR PERMIT STAFF ONLY <br />0Y11 W, APP <br />PERMIT Z ICJ V <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/rl/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Gen. of Occpuancy Required? <br />❑No ❑Yes []Shell Only <br />Code Year <br />❑2021 ❑201$. 112015 <br />Fire Sprinklers: []Update Existing []New System []Net Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF workshest req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes []No <br />VALUATION CALCULATION: Total` <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved B Date: ZJ <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes []No <br />"In Lieu" Fee: Type: Amount $_ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Muk)Iteo School Dist <br />Park Impact Fees for permits applied for after 111/2022: <br />Park Impact Fee Total $ (net due attercredit for extsting uses) <br />Fee Schedule Used For Calculation (Year): <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PWReview& Worksheet Needed If: <br />[]Sys Dev Eval : <br />[]Water []Sewer []Storm <br />❑Traffic Mitigation Eval <br />❑Site Work/Drainage (shomitriggered) <br />❑Address Letter <br />[]Backgow Prevention for high hazard: <br />(dental, medical, animals, mortuary, <br />hospital, supportive housing) <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit Is Required (Permit #: PW ) <br />AND ❑ is fully digital <br />❑ Is located In this folder <br />❑ Is in a Separate Green Folder goin with We folder for permit issuance) <br />❑ Will be issued separately (separate Green Folder, PW Issued ahead of Bldg) <br />❑ Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: Date: <br />wl� � 1�01' TAC <br />